Previously, we looked at Traumatic Brain Injury (TBI). To recap, a TBI is an injury to the brain as a result of an external force, such as blow to the head. It is a complex injury with a broad spectrum of disabling symptoms. TBI is most common in children under 15 years of age and adults over 65 (CDC). In 2010, TBI contributed to the deaths of over 50,000 people in the US. However, of the more than 280,000 hospitalizations and 2.2 million emergency department visits in that same year, most people lived on with increased odds of developing seizures, endocrine disorders, sleep problems, incontinence, nerve damage, cognitive issues, communication problems and degenerative brain disorders.
Like with probably every condition, there are three facets to reducing the number and damaging effects of TBIs:
- Improve prevention (including awareness)
- Improve detection
- Improve treatments (including access to said treatments)
A review of <clinicaltrials.gov> will show that we currently have 207 open, interventional studies registered under the condition “traumatic brain injury”. So what treatment options are we looking into?
- Post-TBI psycho-support therapies.
- Post-TBI educational tools.
- Neurofeedback-enhanced mindfulness meditation.
- Application of trans cranial stimulation.
- Self-help strategies.
- Drug treatments such as buspirone, ronopterin and amantadine for TBI symptom management.
- Video and virtual reality games to improve function e.g. driving simulations.
- Hyperbaric treatment.
- Lactate therapy.
- Music-based neurological rehabilitation.
- Long-term mild hypothermia.
- Metabolic therapy.
- Bright light therapy.
- Micronutrient supplement.
- Stem cells including adipose-derived and notch-transfected mesenchymal stromal cells (SB623).
The list goes on!
In short, we’re throwing everything including the kitchen sink at this problem.
Put simply, after a TBI, there can be mild to severe damage of the brain tissue. Many treatments aim at reducing, halting and if possible reversing this damage. Put simply, the purpose of stem cell therapy for TBI would be to grow back to damage tissue and hopefully restore some if not all of the functionality of the brain.
A tall order to say the least.
Thus far, it’s far too early to say which way the ball is going to go here but we can talk about early indications.
In a 2013 paper on autologous bone marrow mesenchymal stem cell therapy for TBI, 97 patients (24 in a persistent vegetative state and 73 with disturbed motor activity) who had developed a complex cerebral lesion after TBI were treated with stem cell therapy. From this, three conclusions were made:
- Most importantly, the therapy was well-tolerated.
- Around 40% of patients showed significant improvements in brain function.
- Almost half of those in a persistent vegetative state showed statistically significant improvements in consciousness.
- Almost 40% of those with a motor disorder showed significant improvements in motor function.
- Younger participants responded better than older participants in terms of treatment benefits.
- Where the treatment was received earlier on, it was significantly more effective.
A cautionary note: adverse events were only tracked for 14 days after the treatment was administered. It is possible complications related to the treatment occurred after this. Also, this was not a large scale, double-blind, randomized, placebo-controlled study, it was a pilot study to explore the safety of the therapy and explore its possible benefits so it’s tough to draw any conclusions beyond to say the results are interesting and the therapy warrants further investigation.
Another paper in 2013 looked at umbilical cord mesenchymal stem cell transplantation for patients with sequelae of TBI (sequelae here means conditions that occur as a result of TBI). Here we learned that:
- Again most importantly, the therapy was well-tolerated.
- There were significant improvements in neurological function in the treatment group compared to the control group.
- There were significant improvements in self-care in the treatment group compared to the control group.
Another cautionary note: while this group did have a control group and they looked at adverse events 6 months after the last treatment had been received, it was a small 40 participant study and long term improvements beyond 6 months were not recorded. Again, we can take from this only that stem cell therapy is continued research.
So why are mesenchymal stem cells over other types of stem cells being examined?
They’re easy to obtain and grow in vitro; it has been observed that they don’t share the same tumorigenic tendencies that traditional c-myc reprogrammed pluripotent stem cells carry and studies in mice and in vitro studies have shown they may have immunosuppressive and tissue repair properties.
It is thought that stem cells may have neuro-regenerative and neuroprotective capacity. This makes them tempting potential treatments for TBI among other conditions and disorders. However, research is in it’s early days so let’s keep our scientific socks on for now but look optimistically towards the future.